Case Report: Chest Pain Radiating to the Back

Article

Our latest case report features a man in his mid-80s with hypertension, pleural disease, and AF, presenting with 2 days of chest pain radiating to his upper back. Check out the EKG and see if you can determine the correct diagnosis.

History:

A man in his mid-80’s with hypertension, pleural disease and atrial fibrillation on rivaroxaban and carvedilol presents with 2 days of chest pain radiating to his upper back. He describes his pain as constant, waxing and waning, 8/10 in severity and worse with deep inhalation or lying supine. He has had a very slight cough but denies fever, flu or shortness of breath. He also denies diaphoresis, nausea, vomiting, abdominal pain, leg swelling, palpitations or other complaints.

Exam:

Vital signs and physical exam are normal except for an irregular heart rate.

EKG strip

Computer Read: atrial fibrillation at 61 with PVC

What is the most likely cause of the EKG findings in this patient?


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